Keller (right) checks a student's progress after the the final class. The fitness coach worked with an OB-GYN from Weill Cornell Medicine to standardize and evaluate her exercise program, which primarily targets abdominal muscles.

The key exercise is typically performed while sitting crossed-legged, standing up or on all fours. But during Keller's four-week class, she teaches many versions of the exercises. Tania Higham (left) and Maeve Clancy do a version laying on their backs.

Talia Herman for NPR

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Originally published on August 15, 2017 1:00 pm

I admit it. I have a "mummy tummy," also known as "mommy pooch." You know, that soft jelly belly you retain after having a baby — it makes you look a few months pregnant.

I've tried to convince myself that the pooch is a valiant badge of motherhood, but who am I kidding? The pooch bothers me. And it turns out it has been causing back pain.

So when I hear that a fitness coach and doctor have come up with a technique that can flatten the pooch quickly and easily, I think, "Why not?"

A few weeks later, I'm rolling out a yoga mat with a dozen other moms and pregnant women in San Francisco.

"We will see a dramatic change," says Leah Keller, who leads the class.

"You can easily expect to see 2 inches off your waist in three weeks of time," Keller says. "That's not an unrealistic expectation."

Decked out in purple yoga pants and leather cowboy boots, Keller is a personal trainer from New York City. She has developed an exercise that allegedly shrinks the mommy pooch.

There is science to back up the method, she says.

"A doctor at Weill Cornell and I did a study on the exact same program we're going to do," Keller says. "And we found 100 percent of women achieved full resolution."

OK! Wait a second. Two inches off my belly in three weeks? That sounds too good to be true. I decide to do a little digging into the science of mummy tummy and Keller's claim.

Putting the six-pack back together

It turns out the jelly belly actually has a medical name: diastasis recti, which refers to a separation of the abdominal muscles.

And it's quite common. Last year, a study from Norway reported about a third of moms end up with diastasis recti a year after giving birth.

"This is such a ubiquitous issue," says Dr. Geeta Sharma, an OB-GYN at Weill Cornell Medical Center-New York Presbyterian Hospital.

And it's not just a cosmetic problem. Diastasis recti can cause another problem for new moms: lower back pain.

"People can start feeling some back pain because the core is weakened," Sharma says.

In rare occasions, the tissue in the abdomen isn't just stretched, but it is also torn a bit. This can cause a hernia, Sharma says.

"If there's a defect in a layer of tissue called the linea alba, then the bowel can poke through," Sharma says. "That's going to be more dangerous."

A hernia may require surgery. "So I will refer patients to a general surgeon to have a CT scan if there's really a true concern about a hernia," Sharma says.

"These are the muscles that give you a 'six pack,' " says Dr. Linda Brubaker, an OB-GYN at the University of California, San Diego. "People think these muscles go horizontal across the belly. But they actually go vertical from head to toe."

The rectus abdominal muscles should be right next to each other, on either side of the belly button, Brubaker says. "There shouldn't be much of gap between them."

But during pregnancy, a gap opens up between the muscles, right around the belly button. Sometimes that gap closes on its own, but other times, it stays open.

That leaves a spot in the belly where there is very little muscle to hold in your stomach and other organs, a spot that can be 1 to 2 inches wide. That lets the organs and overlying tissue bulge out — and cause mommy pooch.

To flatten the area, women have to get those abdominal muscles to realign. And that is where the exercises come into play.

If you search online for ways to fix diastasis recti, you'll turn up a deluge of exercise routines, all claiming to help coax the abdominal muscles back together.

But the quality of much of that information isn't good, Brubaker says. "Some of it is actually potentially harmful."

Even some exercises aimed at strengthening the abdomen can exacerbate diastasis recti, says Keller, including simple crunches.

"You have to be very careful," she says. "For example, please don't ever again in your life do crossover crunches or bicycle crunches. They splay your abs apart in so many ways."

That said, there are a few exercise programs for diastasis recti that many doctors and physical therapists support. These include the Tupler Technique, Keller's Dia Method and the MuTu System in the U.K.

Most such courses, taught once a week for an hour in New York, San Francisco and at least a few other places, tend to run about four to 12 weeks and cost around $100 to $300. Some places offer online classes and videos, which are much less expensive.

The American College of Obstetricians and Gynecologists also recommends abdominal exercises for the perinatal period. But the organization's guidelines don't provide details — such as which exercises work best or how often women should do them and for how long.

Plus, ACOG focuses more on preventing diastasis than on fixing the problem; it recommends strengthening the abdomen before and during pregnancy.

"The best way is prevention," says Dr. Raul Artal, an OB-GYN at St. Louis University, who helped ACOG write its exercise guidelines for the perinatal period. "The best way to do that is to exercise during pregnancy."

But, as Sharma, the Cornell OB-GYN, points out, no one has really vigorously studied these various exercises to see whether they actually fix diastasis recti.

"There's a general knowledge that exercise is going to help," Sharma says. "But no one has really tested them in a standardized way."

In fact, the few studies that have been done haven't been high enough quality to draw conclusions, researchers in Australia said a few years ago.

Sharma hopes to change that. A few years ago, she teamed up with Keller to start to gather some evidence on her technique.

"We did a pilot study to see if the method is helpful for women," Sharma says.

The study was small — just 63 women. But the results were quite promising. After 12 weeks of doing Keller's exercise — 10 minutes a day — all the women had fixed their diastasis recti, Sharma and Keller reported at ACOG's annual meeting few years ago.

"We had patients that were even one year out from giving birth, and they still had such great benefit from the exercises," Sharma says. "We love to see that there is something we can do to help women."

Now Sharma says she is working to put together a larger study to really nail down when the exercise works and how well.

Tight and tighter

Back at the class in San Francisco, Keller is taking us moms through the key exercise. It's surprisingly simple to do.

"The exercise is a very small, very intense movement that's almost imperceptible," Keller says. "OK. We're going to do another set."

Sitting on the floor cross-legged, with our hands on our bellies, we all take a big breath. "Let the belly fully expand," Keller says.

And then as we exhale, we suck in our belly muscles — as far back as they'll go, toward the spine. "Now we're going to stay here near the spine. Hold this position," she says.

Then we take tiny breaths. With each exhale, we push our stomachs back further and further.

"Tight, tighter," Keller chants, rhythmically.

You can do the exercise in several different positions, Keller says: sitting crossed-legged, sitting on your knees, standing with knees slightly bent, on all fours or laying on your side in the fetal position.

The key is to be sure your back is flat, and that you do the exercise 10 minutes each day, changing positions every two minutes or so. For the rest of the time, your belly is pulled all the way back into the spine.

"The fingertips on the bellybutton are really important for this reason," she says. "So you know that you're squeezing tight, tighter with the belly, and you're never bulging the bellybutton forward."

This is our fourth week of class, and we've been doing this same exercise on our own every day for at least 10 minutes. So it's judgment day. Time to see whether we've flattened our bellies and resolved the diastasis recti.

Keller pulls out a measuring tape and starts wrapping it around women's middles. She also has us lie down on the floor, so she can measure the separation in our abdominal muscles.

One by one, there is success after success. Several moms completely closed up their abdominal separations. Many lost inches from their bellies.

How did I fare? Well, after three weeks, I didn't completely close up the abdominal separation. My separation decreased from 1.2 inches to 0.8 inches.* But I did drop more than an inch from my belly circumference.

And I am quite happy with the results. My abs are definitely firmer. And regularly doing this exercise brought a bonus benefit: My lower back pain has almost completely gone away.

*I continued to do the exercises after the class had finished. I checked with in Keller three weeks later to have her measure my diastasis recti. At that point, the separation had dropped down to 0.6 inches, which meant technically I no longer have diastasis recti.

Copyright 2017 NPR. To see more, visit http://www.npr.org/.

AILSA CHANG, HOST:

Today in Your Health, we're going to tackle an issue that affects about half of all mothers. The technical term is diastasis recti, but many of us know it by another name - mommy pooch - you know, that soft belly that bulges out a bit. Well, ladies, now a fitness trainer and a doctor say they have come up with a quick way to fix it. NPR's Michaeleen Doucleff tried it out to see if it really works.

MICHAELEEN DOUCLEFF, BYLINE: OK, so I admit it. I have mommy pooch. I had my first baby about a year and a half ago. And my stomach - well, it feels a bit like pudding even though I've lost all the baby weight. So when I saw an ad on Facebook for a class that could possibly fix the pooch, I thought, why not? A few weeks later, I'm rolling out a yoga mat on the floor with a dozen other moms in San Francisco.

UNIDENTIFIED WOMAN #1: Hi.

DOUCLEFF: The class is led by Leah Keller, a personal trainer from New York City.

LEAH KELLER: Thank you so much for coming. I'm excited to...

DOUCLEFF: She's decked out in yoga pants and cowboy boots. She's in impeccable shape and has seemingly endless knowledge about abdominal muscles.

KELLER: We're going to get the obliques to fire along with the transverse rectus when we're doing the core compressions.

DOUCLEFF: She starts off by explaining what causes mommy pooch in the first place.

KELLER: So if you've had a baby - and all of you in here have mentioned that you have babies or children - you probably had some degree of abdominal separation.

DOUCLEFF: Abdominal separation - that's the key. Basically, when you're pregnant, the growing fetus pushes apart your abdominal muscles right around your bellybutton. In some cases, the separation closes on its own. But often, it stays open.

KELLER: So if you have this condition, you will have somewhat of a pooch.

DOUCLEFF: Because there's a gap in the muscles, there's nothing to hold in your stomach and your other organs, so they just kind of bulge out.

KELLER: When the muscles don't come back together, you kind of look like you might be, like, four months pregnant, five months pregnant, depending on the severity.

DOUCLEFF: And so to help moms get rid of the pooch, Keller has developed an exercise - one key exercise that is supposed to pull the muscles back together. She says all you need to do is this exercise 10 minutes a day. And then...

KELLER: We will see dramatic change. You can easily expect to see two inches off your waist in the - in three weeks of time. That's not an unrealistic expectation.

DOUCLEFF: OK, wait a second. Two inches off my belly in three weeks - are you kidding? This sounds too good to be true. So I started digging into the science behind Keller's claim and called up one of the doctors who helped develop the method. Her name is Dr. Geeta Sharma. She's an OB-GYN at Weill Cornell Medical in New York City. And she's seen hundreds of women with abdominal separation.

GEETA SHARMA: This is such a ubiquitous issue.

DOUCLEFF: Which, she says, occurs in over 40 percent of new moms. And Sharma says abdominal separation is not just a cosmetic problem. It can also cause another big issue - back pain.

SHARMA: People will start feeling some back pain, and we don't want them to just have to live with their pain. We want them to be able to do something to try and help make it better and keep it from getting worse.

DOUCLEFF: ...Which brings us back to the exercises. If you search on the internet for ways to fix abdominal separation, you'll get a deluge of information. Even the American College of Obstetricians and Gynecologists has its own exercise suggestions, which it recommends doing while still pregnant. But Sharma says there's a big problem. No one has rigorously studied these exercises to see if they work.

SHARMA: There is a general knowledge that exercise is going to help - but not really studied in a very standardized way.

DOUCLEFF: Now she wants to change that. A few years ago, she teamed up with Keller to start testing her method.

SHARMA: What we looked at was a pilot study to try and assess the efficacy.

DOUCLEFF: And the results were quite promising. Sharma presented them at ACOG's annual meeting. The study was small - just 63 women. But after 12 weeks of doing Keller's exercise, all the women had fixed their abdominal separation, even moms who had had a baby a year before.

SHARMA: And that was really reassuring - that they still had such great, you know, benefit from doing the exercises.

DOUCLEFF: So, actually, these exercises do, like, heal that area and bring those muscles back together?

SHARMA: They can. And, you know, we love to see that. We love to see that there's actually something that we can do to help.

DOUCLEFF: So now the pressure is on for me to fix the mommy pooch. If other moms can do it, I should be able to do it, too.

KELLER: OK. We're going to do another set.

DOUCLEFF: Back at the class in San Francisco, Keller is leading the moms through the key exercise. And it's surprisingly simple to do.

KELLER: Relax the shoulders.

DOUCLEFF: We are all sitting on the floor cross-legged with our hands on our bellies. Then we take a deep breath.

KELLER: Let the belly fully expand.

(SOUNDBITE OF EXHALE)

DOUCLEFF: As we exhale, we suck our bellybuttons back as far as we can.

KELLER: Exhale. Squeeze all the way back to the spine.

(SOUNDBITE OF EXHALE)

DOUCLEFF: Then we hold in this position, and take little tiny breaths.

KELLER: And exhale as you squeeze tighter.

(SOUNDBITE OF BREATHING)

DOUCLEFF: With each breath, we pull the belly back further and further into the spine...

KELLER: Very small, very intense, very tight squeeze...

(SOUNDBITE OF BREATHING)

DOUCLEFF: ...For 10 minutes.

KELLER: And you're done. Good work.

DOUCLEFF: This is our fourth class, and it's also Judgment Day. Keller pulls out a measuring tape...

(SOUNDBITE OF MEASURING TAPE EXTENDING)

DOUCLEFF: ...And starts wrapping it around women's bellies to see how many inches they've lost.

KELLER: Who's next?

DOUCLEFF: There's just success after success. Some moms completely closed up the abdominal separation.

KELLER: You are as tight as you can be.

UNIDENTIFIED WOMAN #2: All right (laughter).

KELLER: You scored A-plus. Wow, amazing.

DOUCLEFF: One woman had incredible results.

KELLER: Oh, my goodness, Cat (ph). You made a dramatic improvement in the belly circumference.

DOUCLEFF: She lost nearly 4 inches off her belly in three weeks.

KELLER: Whoa.

DOUCLEFF: Then it's my turn. And I'm really nervous.

KELLER: She's, like, hiding. OK, are you ready?

DOUCLEFF: Let's get this over with. I'm ready (laughter).

In the end, I didn't quite fix my abdominal separation. It got better but not resolved. But my belly circumference...

KELLER: Thirty-three and 3/4 to 32 1/2...

DOUCLEFF: OK, so an inch?

KELLER: So that's an inch and a quarter.

DOUCLEFF: Inch and a quarter, all right.

KELLER: An inch and a quarter...

DOUCLEFF: ...Dropped more than an inch. And, actually, I'm super happy with the results. My stomach is much firmer. But the best part - the exercise really cut down on my back pain. Michaeleen Doucleff, NPR News.

CHANG: At NPR's Shots blog, you can find more tips and also figure out if you have abdominal separation.